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Report (97) , /hS. 07 - 0c.)`30s • wow(.,...„. FIRE SAFETY SYSTEMS AQUASAFETM' FLOW TEST " ` VERIFICATION AquaSAFE1M Flow Test Verification Form Alliance Important:Installing contractor must submit this Member ID: _ completed form.Failure to do so nullifies the _f_f P�t&Mllb�n _ it tv system warranty.E-mail or fax completed form Company Name: ___A46, n- y— to the Uponor Fire Safety Design Department Contact _ 1�Mir _ at technicalservic�i pononcom or 952.997,1737, Phone ___ (j�- �. y For questions,contact Uponor Technical Services at O 888594.7726 or technical Se vi i_ponor com. Fax: _ / -- Color of test orifice used: Job Name: 21 4(_A_cc c r �., 2 Static pressure(not flowing)reading at incoming Project Number: _�� water supply into home or at main shutoff: 'I-_ --_— _ PP Y Job Address: _ _S 41 City: — {qC>� Residual pressure(flowing)reading at inco ing water supply into home or at main shutoff: State,ZIP: ©R 9, _ For designs not provided by Uponor, complete the What time of day was the flow test taken? tcI following information. Flow test method used? Bucket J Flow Meter Designer's Name: _��P K 1�',a,— Flow test gpm:_ Company: _ Li, ( (' ,r _ How many gallons of water did the design predict Phone: __9__5:1-__A- �� J 5a© as required?_______O — --- Did the test meet or exceed design flow?Fax: If Yes 3 No Is the warning sign permanently attached close to the Which sprinkler did you flow?Number:_ f . main shutoff valve? J Yes ;;1 No OilFAI(51. Location of head:_(Ne, Was this system required by code?( Yes J No I\ Date left in service with all valves open: L�� Tom` n Test Witnessed and Verified by: Name Si. atu [ �pl re Occupatio Date izs1. g Additional Explanations and Notes mmo , g LLI E Uponor,Inc. Tel:800.321.4739 5925 148th Street West . Fax:952.997.1731 _1. Apple Valley,MN 55124 USAWeb:www.uponor-usa.com